CMS/EIP Fiscal Report Center: 51
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Eligibility Filter:DEI Only
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 1.25 46.25 37.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 7.25 268.25 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 11 56.75 2099.75 37.00
Subtotal (Total Children Is Unduplicated) 11 65.25 2414.25 37.00
----------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.00 150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.00 75.00 75.00
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 3.00 225.00 75.00
Subtotal (Total Children Is Unduplicated) 3 6.00 450.00 75.00
----------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 4.00 400.37 100.09
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 11.00 550.00 50.00
PHY-97110-PT SESSION BY LICENSED PT 1 6.25 424.25 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 33.00 2240.04 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 6 1622.00 741.00 0.46
Subtotal (Total Children Is Unduplicated) 6 1676.25 4355.66 2.60
----------------------------------------------------------------------------------------------------------------
Total 1747.50 7219.91 4.13
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11
----------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 47 40.00 1632.00 0.00
P 36 1662.25 3294.37 3294.37
D 5 3.50 129.50 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
58 41.75 2164.04 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 146 1747.50 7219.91 3294.37